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Background  Chloride administration has been found to be harmful to the kidney in critically ill patients. However the association between plasma chloride concentration and renal function has never been investigated.    Methods  This was a retrospective study conducted in a tertiary 24-bed intensive care unit from September 2010 to November 2012. Data on serum chloride for each patient during their ICU stay were abstracted from electronic database. Cl 0  referred to the initial chloride on ICU entry, Cl max , Cl min  and Cl mean  referred to the maximum, minimum and mean chloride values before the onset of AKI, respectively. AKI was defined according to the conventional AKIN criteria. Univariate and multivariable analysis were performed to examine the association of chloride and AKI development.    Results  A total of 1221 patients were included into analysis during study period. Three hundred and fifty-seven patients (29.2%) developed AKI. Cl max  was significantly higher in AKI than in non-AKI group (111.8 ± 8.1 vs 107.9 ±5.4 mmol/l; p < 0.001); Cl 0  was not significantly different between AKI and non-AKI patients; Cl mean  was significantly higher in AKI than non-AKI (104.3 ±5.8 vs 103.4 ± 4.5; p = 0.0047) patients. Cl max  remained to be associated with AKI in multivariable analysis (OR: 1.10, 95% CI: 1.08-1.13).    Conclusion  Chloride overload as represented by Cl mean  and Cl max  is significantly associated with the development of AKI.

Higher serum chloride concentrations are associated with acute kidney injury in unselected critically ill patients